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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/18/2023 <br />Name Zach Hurst Department DPW <br />BPW Date 06/13/2023 Phone Extension 3057 <br /> <br />Review and Approval Required Prior to Submittal to Board Diversity Compliance <br />and Inclusion Officer Officer Name BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br /> Professional Services Agreement Contract Proposal <br /> Open Market Contract Amendment/Addendum Special Purchase, QPA <br /> Bid Opening Bid Award Req. to Advertise Title Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. 3 [Final] Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Gibson-Lewis LLC <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name Muessel Grove Park Restroom <br />Project Number 118-099R2 <br />Funding Source Park Bond Capital, RWDA TIF <br />Account No. PO-0019070 <br />Amount $8,101.00; Revised Amount: $416,803 <br />Terms of Contract <br />Purpose/Description Change Order 3 addresses water line winterization and fan control <br />modification. <br />For Change Orders Only <br />Amount of <br /> <br />Increase <br />Decrease <br />$ 8,101.00 <br />($ ) <br />Previous Amount $ 408,702.00 <br />Current Percent of Change: <br />Increase <br />Decrease <br />1.98% <br />( %) <br /> New Amount $ 416,803.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />4.86% <br />( %) <br /> Time Extension Amount: <br />New Completion Date: <br />